Historically, electrosurgical forceps have had two shanks, and one variation had two opposing pads on the inside of the forceps shanks that made contact when the forceps tips were pressed together. Another version included a cup on the inside of one shank and a pin on the inside of the other shank. Both of these types of forceps failed because, during surgery, the switch was inside the patient's body and any fluid entering the switch caused an arc to occur which resulted in the patient being burned. Due to these shortcomings, the original monopolar instruments were withdrawn from the market and the only type of monopolar forceps that remained was an instrument with a foot-activated switch by which the problem of arcing is solved, but the surgeon loses tactile feel and control which naturally is undesirable.
In bipolar electrosurgery, both the active electrode and return electrode functions are located at the surgery site wherein the two shanks of the forceps perform the active and return electrode functions. Bipolar electrosurgery uses a low current and is used on very delicate and precise surgeries such as around the eye, female sterilization and other surgeries wherein minimal tissue damage is desired. The coagulation takes place between the tips of the forceps wherein one side of the forceps is active and the other side is the ground.
Monopolar electrosurgery is the most commonly used method of electrosurgery and is versatile and effective wherein the active electrode is the instrument disposed at the surgical site and the return electrode is located somewhere else on the patient's body in the form of a flat grounding plate. Current passes through the patient as it completes the circuit from the active electrode to the patient return electrode and monopolar instruments use more electrical power than bipolar instruments and usually coagulate larger areas.